Karasakalides Andronikos, Triantafillidou Sofia, Anthimidis George, Ganas Evangelos, Mihalopoulou Evangelia, Lagonidis Dimitris, Nakos George
Department of Surgery, Giannitsa General Hospital, Giannitsa, Greece.
J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):333-8. doi: 10.1089/lap.2008.0279.
The clinical evaluation of the abdomen in intensive care (ICU) patients who are intubated can be very complex. Many bedside diagnostic tests are available to assist the clinician, including ultrasound, peritoneal lavage, and plain X-rays. However, in the ICU setting, these tests can be unreliable. An abdominal computed tomography (CT) scan is more reliable, but it requires transportation to the Radiology Department, which can be risky. In this paper, we present our experience with bedside laparoscopy in the general ICU population.
Between April 2004 and November 2007, 35 adult patients (19 male, 16 female), with a mean age of 69 years (range, 39-83), underwent bedside diagnostic laparoscopy (DL) in the ICU. Hemodynamic and ventilatory parameters as well as the time required for the DL and CT scan procedure were compared. In addition, the ASA, APACHE II, and SOFA scores were documented.
Laparoscopic findings were negative for intra-abdominal disease in 57.1% (n = 20) patients. The remaining patients (42.9%; n = 15) had positive laparoscopic findings for intra-abdominal disease. The overall mortality rate in our group of patients was 60%. The time required for DL was less (21.8 +/- 7.6 minutes) than the time required for a CT scan (38.2 +/- 6.2 minutes; P < 0.05). Three patients went on to have a therapeutic procedure in the ICU.
The evaluation of the critically ill patient for intra-abdominal pathology with DL is a practical solution and needs to be used more frequently in this setting. In this paper, we present our experience with diagnostic laparoscopy in the ICU and found it to be safe and, in certain cases, may have a potential role as a bedside therapeutic tool. Although a number of reports with small series of patients have addressed the benefits and feasibility of DL, it is still being underutilized in the ICU. A more aggressive attempt should be made to incorporate DL as a routine procedure in the ICU.
对重症监护病房（ICU）中已插管患者的腹部进行临床评估可能非常复杂。有许多床旁诊断检查可协助临床医生，包括超声、腹腔灌洗和平片X线检查。然而，在ICU环境中，这些检查可能不可靠。腹部计算机断层扫描（CT）更为可靠，但需要转运至放射科，这可能存在风险。在本文中，我们介绍了在普通ICU患者中进行床旁腹腔镜检查的经验。
在2004年4月至2007年11月期间，35例成年患者（19例男性，16例女性），平均年龄69岁（范围39 - 83岁），在ICU接受了床旁诊断性腹腔镜检查（DL）。比较了血流动力学和通气参数以及DL和CT扫描所需时间。此外，记录了美国麻醉医师协会（ASA）、急性生理与慢性健康状况评分系统II（APACHE II）和序贯器官衰竭评估（SOFA）评分。
57.1%（n = 20）的患者腹腔镜检查结果显示腹腔内疾病为阴性。其余患者（42.9%；n = 15）腹腔镜检查结果显示腹腔内疾病为阳性。我们这组患者的总体死亡率为60%。DL所需时间（21.8 ± 7.6分钟）比CT扫描所需时间（38.2 ± 6.2分钟；P < 0.05）短。3例患者在ICU继续接受了治疗性操作。
用DL对危重病患者进行腹腔内病变评估是一种切实可行的解决办法，在这种情况下需要更频繁地使用。在本文中，我们介绍了在ICU进行诊断性腹腔镜检查的经验，发现其安全，并且在某些情况下可能作为床旁治疗工具具有潜在作用。尽管有一些小系列患者的报告阐述了DL的益处和可行性，但它在ICU中仍未得到充分利用。应更积极地尝试将DL纳入ICU的常规操作中。
